Postacute care organizations: a solution for Medicare risk HMOs

A postacute care organization is a company that contracts with HMOs and other types of insurers and risk-bearing groups to ensure the health plan's appropriate and cost-effective use of medical services available outside of the hospital setting. Through proactive and intensive case management of patients and postacute care providers, these organizations minimize inappropriate or unnecessary hospitalizations and deliver the following results to clients: reduced overall medical costs; higher quality postacute care services; increased plan retention of members through increased patient, family, and provider satisfaction. Postacute care organizations represent a solution for Medicare Risk HMOs and other health plans who are experiencing great difficulty in managing the financial risk and operational challenges related to their benefit plans for higher risk groups. Coordinated Care Solutions, Inc. (CCS) is an example of a company meeting the rapidly growing demand for postacute care management services. This article describes why there is a need for these services and studies CCS's model of delivering postacute care management services and value to its clients.